Find out what other moms-to-be are asking. Join in the discussion with Henci Goer, whose expertise is determining what the research tells us best promotes safe, healthy birth. If you would like to contact Henci outside of the Ask Henci forum, send an email to Goersitemail@aol.com.

I have just turned 40, pregnant with my first baby. I am in BC,
Canada, and my OB is telling me that "new research out of BC
Women's Hospital" is indicating that there are risks involved with
letting women of my age go past their due date. She is telling us
that she will begin to induce at 38-39 weeks, by sweeping the
membranes if the cervix isn't ripe yet, and then the usual IV
interventions if that doesn't work. This all seemed fine until I
attended a Lamaze birthing class and found out all that you say on
this site about induction. I plan to talk with my OB about this,
but it may be hard to convince her and I want to know if you've
heard of this "new research" and if you're aware of what risks she
might be talking about for women my age. Specifically, I want to be
able to distinguish between induction for precautionary reasons and
induction for medically necessary reasons, because when she first
presented this to us, it sounded like she was saying it was
medically necessary - at least she didn't present it like she was
asking us.

There have been some
studies suggesting that women aged 40 or more are at higher risk of
stillbirth, but those studies are flawed.
Here is a critique of one explaining that the study did
not consider certain health factors that are more likely to be
found in older women. To the ones listed in the blog post, I would
add that these studies also do not adjust for having had a previous
cesarean, which would be more likely in older women in that older
women would be less likely to be having a first baby. Several
studies have found that prior cesarean increases the risk of
unexplained stillbirth late in a subsequent pregnancy. In other
words, while there may be slightly increased risk in the population
over all, it is unclear what excess risk, if any, would accrue to a
specific woman aged 40 who had none of those risk
factors.

On the other hand,
inducing labor in a first-time mother roughly doubles her risk of
the labor ending in cesarean surgery. In 16 studies looking at this
issue, this amounted to anywhere between 3 and 31 more women per
100 who were induced compared with first-time mothers beginning
labor spontaneously. I should add, too, that while cervical
ripening agents do a good job at ripening the cervix, they do
nothing to reduce the excess cesarean rate associated with
induction, which, of course, is the point of using them. Cesareans
are not risk free for mothers or babies, as you can see by this
fact sheet. Any decision should
take into account the risks on both sides of the equation, not just
one side.

I hope this
helps.

-- Henci

All Times America/New_York

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